Professor and Community Chair for Activity, Nutrition, and Obesity Prevention

College of Public Health. University of Nebraska Medical Center

Buffett Early Childhood Institute at University of Nebraska

​Emeritus Professor at Kansas State University

​A Little about Community Population Health and Wellness

Communities across the U.S. and internationally are working to improve population health to increase human welfare and decrease health care costs. There is evidence that indicators of population health and wellness vary geographically due to the structural conditions of local communities. For example, communities differ in early life developmental and cancer prevention opportunities for children, such as physical activity, healthful eating, and obesity. Some communities have greater health and wellness promoting behavior rates and lower obesity rates, compared to other communities. An omnibus challenge to achieve population health and wellness improvement, therefore, is to facilitate change in conditions across in the numerous places where people live, learn, work, and play in a geographic area. This a multilevel whole-of-community population health and wellness dynamic system problem.

Positions AvailableScreening to Begin February 1, 2018Start date is no later than August 1

Community Population Health for Children Position AnnouncementsCollege of Public Health, University of Nebraska Medical Center

A Community Population Health Research Program Coordinator, Research Associate, and two Graduate Research Assistants are sought to join our team examining community development, physical activity, nutrition and health promotion for children. Each position will contribute to an innovative 5-year community randomized trial funded by the National Cancer Institute titled Whole-of-Community Systems Intervention for Youth Population Physical Activity (RO1R01CA215420-01A1). Successful applicants will also have the opportunity to participate on other projects that target community population health and child development in child care, elementary schools, and middle schools, which are funded by the USDA, NIH, and foundations

The work will be under the guidance of Professor and Endowed Community Chair, David Dzewaltowski. More information and application is available online for the Research Program Coordinator Position (https://unmc.peopleadmin.com/postings/36576) and Research Associate Position (http://unmc.peopleadmin.com/postings/36620). Graduate Research Assistants should initiate the application process by submitting a letter of application and vita directly to david.dzewaltowski@unmc.edu. Students will have the opportunity to participate in M.P.H. and Ph.D. curriculum opportunities in health promotion and disease prevention research or medical sciences interdepartmental emphasis areas.

Our work is housed in the University of Nebraska Medical Center, College of Public Health and the Buffett Early Childhood Institute at the University of Nebraska and is supported by an endowment. The team contributes to three overarching aims: 1) Contribution to social ecological systems theory development; 2) Evaluation of population health community-wide and organization (child care, schools, after-school program, youth clubs, youth sport) systems development strategies to improve childhood development, physical activity, nutrition, and obesity; and (3) Identification of the distribution and determinants of inequities in community population health of children through observation of community and organization systems. Successful applicants will have the opportunity to contribute to all aims, with in-depth focused work on one aim. Within the team, there are opportunities to develop skills, such as quantitative data collection (observation and accelerometry) and analysis; qualitative data collection and analysis; and peer review paper, report, and grant writing skills. Collaborating investigators on active projects are associated with the Buffett Early Childhood Institute, University of Nebraska Medical Center, College of Public Health (Paul Estabrooks, Brandon Grimm, Jennie Hill, Abbie Raikes, Athena Ramos), UNMC and the Gretchen Swanson Center for Nutrition (Amy Yaroch), Kansas State University (Richard Rosenkranz, George Milliken), Iowa State University (Cornelia Flora, Greg Welk), and Louisiana State University (Senlin Chen).

Contributions to Science

Individual perceptions of self-efficacy determine physical activity

Lack of physical activity is a major public health problem. Dzewaltowski’s early work could arguably be considered to be one of the first lines of research to take on the challenge of identifying the determinants of physical activity from a theoretical perspective. His work compared several psychology discipline theoretical models and in 1989 identified self-efficacy as a central social cognitive process mediating physical activity behavior change. These findings were widely cited and became central to Albert Bandura's books and papers addressing self-efficacy and other social cognitive processes and health behavior theory."Some researchers have tested whether factors included in alternative conceptions of health behavior add incremental prediction over about a subset of sociocognitive determinants. In several of these studies, the sociocognitive determinants included efficacy beliefs, and satisfaction or dissatisfaction with the changes in achieved heath habits (Dzewaltowski, 1989; Dzewaltowski et al, 1990). Both efficacy beliefs and affective self-reaction to personal progress contributed to adherence to healthful behaviors. Attitude and perceived social pressure similarly accounted for healthful behavior, but they did not improve prediction when added to the subset of sociocognitive determinants. Such findings suggest redundancy of determinants under different names rather than dissimilar determinants. (p., 286, Bandura, 1997)." The work supported adopting a social cognitive approach to health behavior change and later helped direct the field toward addressing intervention development targeting psychosocial causal processes within a theory-driven mediation/moderation framework.

Adult and youth setting leaders capacity can be developed to modify their practices to improve children's health behavior.

.Evolving from his earlier health behavior work that was strongly influenced by an individual level approach to health behavior theory, he adopted and ecologically informed social cognitive approach and later an ecological social systems approach to setting intervention. These setting intervention studies were designed to test the effectiveness of a community participatory approach to training adult and youth leaders to adopt evidence-based practices to modify the social and physical environment (context) to promote health behavior in children and youth. The findings demonstrated that the capacity of leaders of youth settings can be developed to modify organizational practices to impact health behavior. Communities have adopted the intervention programs resulting from these studies for implementation. For example, the National Cancer Institute has listed the Scouting Nutrition and Activity Program as a "research-tested intervention program."

With an understanding that leaders of child development settings can be trained to modify organizational practices to improve the social and physical environments of youth to promote health behavior, one line of his recent work has focused on further identifying the implementation of organizational practices of these settings that are related to increased physical activity using observation of physical and social environments and measurement of physical activity with accelerometers. With this information, his work will contribute to refining interventions that train youth leaders to promote healthful behavior. These studies have demonstrated that the contextual factors promoting physical activity (e.g., social, solitary) interact with individual differences, which suggests that interventions can be tailored with precision for larger health behavior outcome effects

Ecological validity is essential to implementation success

Dr. Dzewaltowski was also a founding member of the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) work group, whose goal has been to encourage program planners, evaluators, readers of journal articles, funders, and policy-makers to pay more attention to essential program elements that can improve the sustainable adoption and implementation of effective, evidence-based health promotion programs. The RE-AIM framework is rooted in implementation and dissemination science and has spread over the last 15 years. In a recent network analysis of the RE-AIM Framework publications, Dzewaltowski was identified as the 7th highest author in centrality to the spread across the international network of implementation science researchers.

Contribution to the development of generalizable principles to guide practices, programs, and policies through the development of a ecological systems theory that addresses inequity of opportunity.

While the project name is new, our team has been collaborating with communities and organizations in integrated research and practice efforts building healthy places (www.healthyplaces.org) where "children live, learn, work and play" (Dzewaltowski et al., 2002, p. 2010)" to promote population health outcomes in children, youth and families targeting physical activity, nutrition and other health behaviors since 1999.

Scientists studying implementation science for population health outcomes can access a set of resources and talks on grant writing for "Translating Effective Interventions into Practice: An Interactive, Pragmatic Workshop for T3-T4 Research as part of the Great Plains Idea - Clinical & Translational Research Forum.

Health Opportunities for Physical Activity and Nutrition (HOP'N) After School

We have had several successful projects demonstrating that communities can improve population health outcomes in children. Left is a news story from several years ago reviewing our HOP'N After School Project (Dzewaltowski, et al 2010). This was one of the first school randomized trials to demonstrate improved physical activity outcomes in children by increasing the capacity of the community and after school program leaders.

Recent News​

My team is seeking Ph.D. and MPH students interested in careers as scientists studying processes and interventions that impact community population health. Please contact Dr. David Dzewaltowski directly (David.Dzewaltowski@unmc.edu).

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